Novitas Solutions

What Novitas Solutions does

Novitas Solutions, Inc. is a Medicare Administrative Contractor (MAC) that processes and adjudicates Medicare claims under contracts with the U.S. Centers for Medicare & Medicaid Services (CMS). It operates three concurrent MAC contracts: Jurisdiction L (covering Pennsylvania, West Virginia, Virginia, and surrounding areas for Parts A and B), Jurisdiction H (covering Texas, Arkansas, Colorado, Louisiana, Mississippi, New Mexico, and Oklahoma for Parts A and B), and NPEAST DMEPOS (durable medical equipment across a multi-state eastern footprint). The company is a subsidiary of GuideWell Source, with First Coast Service Options operating as a sister MAC.

The company serves healthcare providers — principally hospitals, physicians, and DMEPOS suppliers — operating within its assigned jurisdictions. Its core products are provider-facing portals (Novitasphere and jurisdiction-specific sites), claims processing and adjudication systems, medical review and appeals workflows, and educational/provider outreach services. It is also participating in CMS's WISeR (Wasteful and Inappropriate Service Reduction) prior authorization model in partnership with Genzeon, which expands its scope from traditional post-payment review toward pre-payment utilization management. The company is ISO 9001:2015 certified, indicating a formalized quality management system across operations.

Novitas employs more than 2,000 people, with roughly half at its Mechanicsburg, Pennsylvania headquarters and the remainder distributed across field offices in Pittsburgh, Williamsport, Dallas, Milwaukee, and Jacksonville. The business model is contract-based: revenue flows from CMS under MAC fee-for-service pricing, with compensation tied to claims processed, medical reviews performed, and provider services delivered under the contract scope. There is no public financial disclosure; the company is privately held within GuideWell, a mutual insurance holding company.

Name

Novitas Solutions

Legal name

Novitas Solutions, Inc.

Website

https://novitas-solutions.com

Company type

Private

Founded year

1965

Operating status

Operating

Headcount range

1,001–5,000 employees

Short description

Novitas Solutions is a Medicare Administrative Contractor that processes and adjudicates Medicare claims for healthcare providers under three CMS contracts (Jurisdictions L, H, and NPEAST DMEPOS), operating as a subsidiary of GuideWell Source with 2,000+ employees across six U.S. offices.

Ownership category

akta.pro rank

Product category

Medicare Administrative Services

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Administration of Public Health Programs (923120)

SIC

Hospital & Medical Service Plans (6324), Services-Computer Programming, Data Processing, Etc. (7370)

akta.pro primary industry

Medicare Plan Administration & Third-Party Services (TPA/BPO, Enrollment, Billing) (FSAIAGAI)

akta.pro secondary industry

Government Program Administrative Services (Medicare/Medicaid ASO/TPA) (HLAEALAO)

Keywords

• Medicare claims processing
• Provider enrollment services
• Medicare Administrative Contractor
• Healthcare administrative services
• DMEPOS supplier enrollment

Headquarters

HQ city

Camp Hill

HQ country

United States

HQ region

North America

Offices6 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Infrastructure, Marketing or Sales

Revenue model

1. Medicare Administrative Contractor Services: Administrative services processing for government-sponsored healthcare programs under contract with the Centers for Medicare & Medicaid Services (CMS). Revenue is derived from government contracts to process Medicare claims, manage provider enrollment, and perform compliance oversight for designated jurisdictions.

Go-to-market motion1 record

Distribution channels4 records

Marketing channels6 records

Core offering

Novitas Solutions serves as a Medicare Administrative Contractor (MAC) for the Centers for Medicare & Medicaid Services (CMS), administering three government contracts: Jurisdiction L (Delaware, DC, Maryland, New Jersey, Pennsylvania, and parts of Virginia), Jurisdiction H (Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas, plus IHS and VA nationally), and the NPEAST DMEPOS provider enrollment contract spanning 28 states/territories. The company processes Medicare Part A and Part B claims, handles provider enrollment and oversight, conducts medical review, manages appeals and redeterminations, and administers prior authorization (including the WISeR model) for physicians, hospitals, skilled nursing facilities, DMEPOS suppliers, and other healthcare providers.

Product overview

Novitas Solutions operates as a Medicare Administrative Contractor (MAC) administering three primary government contracts: Medicare Jurisdiction L (JL) covering Mid-Atlantic states, Medicare Jurisdiction H (JH) covering South-Central states, and the NPEAST DMEPOS national provider enrollment contract. The company provides claims processing, provider enrollment, medical review, and appeals administration services through its Novitasphere online portal. Providers access these services through dedicated websites for each contract jurisdiction.

Differentiator

Problem solved

Functional benefit

Products and services

• Medicare Administrative Contract Jurisdiction L (JL)

Named customers6 records

Segments3 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature4 records

Partnerships

Four partnerships are on record, tiered core and minor.

• GuideWell SourcecoreOthersParent company of Novitas Solutions. GuideWell Source is part of the GuideWell family of companies, which includes Florida Blue and other health insurance and healthcare services organizations.
• First Coast Service OptionsminorOthersSister company operating under GuideWell Source. Also a Medicare Administrative Contractor serving different jurisdictions.
• Centers for Medicare & Medicaid Services (CMS)coreStrategic or Co-development PartnerFederal agency that contracts Novitas Solutions as a Medicare Administrative Contractor (MAC) to process Medicare claims and administer health care programs in designated jurisdictions. Relationship governed by government contracting.
• GenzeoncoreStrategic or Co-development PartnerWISeR (Wasteful and Inappropriate Service Reduction) model participant responsible for reviewing prior authorization requests for New Jersey providers under the CMS innovation program.

Scale indicators4 records

Recent moves4 records

Expansion highlights3 records

Broad incumbents

• Maximus: Government services contractor with a large health segment including eligibility, appeals, and CMS operations support. Provides adjacent administrative services to federal healthcare programs.
• Conduent: Public company providing healthcare claims administration, eligibility, and provider services for government payers. Operates at greater scale than Novitas across multiple government health programs.
• Gainwell Technologies: Large government healthcare IT and services vendor serving state Medicaid and federal programs. Broader in scope than Novitas but competes for adjacent CMS technology and administration contracts.
• GuideWell Source (Parent): Novitas' parent operating company within the GuideWell/Florida Blue family. Holds the corporate umbrella for Novitas and sister MAC First Coast, providing shared services, IT, and strategic direction.

Direct peers

• National Government Services: An Anthem subsidiary operating as a MAC for multiple jurisdictions (J6, JK, J5). Directly competes with Novitas on government contracts and serves overlapping provider types.
• First Coast Service Options: Sister company under GuideWell Source and fellow Medicare Administrative Contractor. Operates adjacent MAC jurisdictions with the same operating model, contract structure, and provider-facing services, making it the most directly comparable peer.
• Noridian Healthcare Solutions: MAC contractor serving Jurisdictions JE, JF, and JH successor. Competes head-to-head with Novitas on MAC procurements and delivers the same Part A/Part B claims administration services.
• Wisconsin Physicians Service Insurance: MAC contractor administering Jurisdictions J5 and J8. Comparable MAC services portfolio with similar claims processing, provider enrollment, and audit responsibilities.
• Palmetto GBA: A division of BlueCross BlueShield of South Carolina operating multiple MAC jurisdictions (JJ, JM, JI). Directly competes with Novitas for CMS administrative contracts and serves similar provider populations.
• CGS Administrators: A Cigna-owned MAC administering Jurisdictions J15 and J6 for Part A and Part B. Comparable in scope, contract structure, and provider-facing Medicare services.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat3 records

Key risks6 records

Key highlights7 records

Customer concentration

• YouTubeyoutube.com/c/NovitasSolutionsInc
• LinkedInlinkedin.com/company/novitas-solutions-inc
• Xx.com/NovitasSolution

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Novitas Solutions